Exxcellence pearls: Tubo-ovarian abscesses in nulligravid

Question 0

What are complications of TOA?

Answer 0

Infertility, ectopic pregnancy, chronic pelvic pain, pelvic thrombophlebitis, ovarian vein thrombosis.

Question 1

What percentage of women with PID will have a tubo-ovarian abscess?

What percentage of women with PID requiring admission will have TOA?

Answer 1

15%

33%

Question 2

What bacteria are thought to facilitate TOA infection?

What bacteria are typically isolated from TOA’s?

Answer 2

Neisseria gonorrheae and chlamydia trachomatis.

Escherichia coli and Bacteroides species.

Question 3

How is TOA historically treated?

What are modern treatment recommendations and dosing?

Answer 3

Hysterectomy and BSO.

Cefotetan 2 g IV Q 12 hours or cefoxitin 2 g IV Q6 hours for 24 hours plus doxycycline 100 mg PO or IV Q 12 hours for 24 hours. Then clindamycin or metronidazole plus doxycycline PO 14 days.

Question 4

What percentage of patients fail parenteral antibiotics in 48 to 72 hours?

How should this be managed?

Answer 4

25%

Surgery or drainage. Transvaginal drainage has a 90% success rate and is associated with shorter hospital stays and decreased morbidity.